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People with learning disabilities still face inequalities in access to health services. This article, which comes with a handout for a journal club discussion, sums up what nurses can do to reduce these inequalities

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People with learning disabilities still face inequalities in access to health services. This article, which comes with a handout for a journal club discussion, sums up what nurses can do to reduce these inequalities

Community nurses have 'serious concerns' about GP commissioning

The move to GP commissioning could exclude other clinicians from decision making while increased competition in the NHS will lead to cost cutting, reductions in quality and greater inequalities, according to the Queen’s Nursing Institute.

In its response to the Liberating the NHS white paper, the community nursing organisation said while abolishing targets would be welcome to take the pressure off parts of the service, nurses were worried about losing the benefits to patients from reduced waiting times.

It said the introduction of GP commissioning raised serious concern, because of “the GPs’ vested interests, the exclusion of other professionals who could have contributed usefully, and the complexity of the task which might create inequalities for the more excluded or complex patient groups”.

The QNI added: “The development of competition amongst providers – although understood in principle to be about making everyone strive to be the best - was widely condemned as likely to lead to cost cutting, reductions in quality and greater inequities in service provision.”

However, the institute said it supported proposals to increase joint working between the health service and local authorities, as this would “give patients a better experience of ‘joined up’ care, and more personalised services”.

Overall, the QNI called on the government to address community workforce issues.

Morale among community nurses was “undoubtedly very low”, it warned, because of reductions in staff numbers, downgrading of posts, the ending of innovative projects and forced early retirements.

It said: “There is no alternative workforce to deliver services, even under competition.

“It is essential that the workforce issues are addressed early on – including the falling numbers of community specialists, highly diluted skill mix, rapidly-increasing use of health care assistants to do nursing tasks, and exclusion of all but GPs from input into planning, commissioning and designing services.”

The response was drawn up by Queen’s Nurses, the QNI’s community nurse forum and the institute’s professional staff.

“Tennis elbow jab makes it worse,” said the headline, six weeks after I’d had a jab for tennis elbow. “Is it like RSI?” I had asked my doctor. “No such thing as RSI,” he said, “that’s a made up diagnosis”.

The chief nursing officer for England Dame Christine Beasley has moved to try and ensure nurses have a voice in NHS spending decisions when commissioning responsibility shifts from primary care trusts to GPs.

Community-based rapid response teams will be expected to swing into action within two hours to prevent vulnerable patients being taken to hospital as part of efforts to provide more care closer to home.

The problem is that Andrew Lansley has probably no idea of how bad GP management can be and only takes advice from organizations such as the self back patting and exclusive medical organizations. Of course GPs want more power, more money, look at the increase in salary from the GP contract a few years ago, and how GPs had to be dangled a carrot to do the job they should have been doing in the first place! That was in days when I was asked by my GP employer not to look, lest I should find!

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